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Home My WebLink About2270 LA COSTA AVE; 1; CB930866; PermitT \ l-'1. .., 12 jRj"', q "!. .. .. .2 Ho SlO l>sO l :r tl '. # i I\ ~ 1\ I-\ [ : r E ' A X ( ' r ' ,A , I t ~ I r ._.. T w • A CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 PERMIT APPLICATION PLAN CHECK NO. City of Carlsbad Building Departaent 2075 Las Pal.,.s Dr., Carlsbad, CA 92009 (619) 438-1161 EST.VAL ___________ _ PIAN CK DEPOSIT. ________ _ VAIID.BY, __________ _ I. PfltMII hPE DATE A-UCommerc1al □New Bmldmg U lenant Improvement B -□ Industrial D New Building D Tenant Improvement C -Xl Residential □ Apartment □ Condo QI Single Family Dwelling □ Addition/ Alteration □ Duplex □ Demolition □ Relocation □ Mobile Home □ Electrical D Plumbing □ Mechanical □ Pool □ Spa □ Retaining Wall □ Solar □ Other 2. PROJECf INFORMATION FOR OFFICE USE ONLY ress u1 mg or u1te o. 2270 La Costa Ave. #1 Nearest Cross Street LEGAL DESCRiPIIUN Lot No. Su&hvts1on Name/Number Omt No. Phase No. CHECK BEWW IF SUBMll 1£0: D 2 Energy Gales □ 2 Structural Cales □ 2 Soils Report D l Addressed Envelope ASSESSOR'S PARCEI. EXlSTING USE PROPOSED USE SQ. IT. # OF STORIES 3. WN IACI PERSON (II dnlerenf from applicant) NAME Les Gjerdedig ADDRESS 2270 La Costa Ave. #1 CITY Carlsbad 4. APPUCANI ucuN1RAC10R STATE CA. ZIP CODE 92009 DAY TELEPHONE 632-8056 XJAGENI FORWNIRACIOk DOWNER DAGEN! FOR OWNER NAME Shelly Andrews c1TY ~aJ Je¥, S. PROP STATE CA ADDRESS 2819 Central Ave. ZIP CODE 9) 977 DAY TELEPHONE 697 41 5) NAME Les Gjerdedig ADDRESS ZIP CODE 2270 La Costa Ave. CITY Carlsbad, STATE CA. 92009 DAY TELEPHONE 632 8056 6. WNlitACIUk NAME A&J Foster, Inc. ADDRESS 2819 Central Ave. CITY Spring Valley, STATE CA. ZIP CODE 91977 DAY TELEPHONE 697-4151 STATE LIC. # 6301 20 LICENSE CLASS C-36 CITY BUSINESS LIC. # J 2 o o 3 5 4 CITY N/A STATE ZIP CODE DAY TELEPHONE STATE LIC. # 7. WORKERS' WMPENSA:llON Workers' Compensation Oeclarat1on: I hereby athrm that I have a certthcate of consen[ to self-msure issued by the Director of lndustnal Relations, or a certificate of Workers' Compensation Insurance by an admitted insurer, or an exact copy or duplicate thereof certified by the Director of the insurer thereof filed with the Building Inspection Department (Section 3800, Lab. C). INSURANCE COMPANY Republic Dernnity POLICY No.PC949585 EXPIRATION DATE 5/1/94 Cemhcate of Exemption: I certify that m the performance of the work for which this penmt 1s issued, I shall not employ any person m any manner so as to become subject to the Workers' Compensation Laws of California. SIGNATU'irn~ ~TE fQt/:, q~ 8. OWNER-HO Owner-Bu1lder OCciarauon: I hereby affirm that I am exempt from the Contracto?s Llcense Law for the following reason: □ I, as owner of the property or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's license Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale.). □ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Ccxle: The Contractor's license Law does not apply to an owner of property who builds or improves thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractor's license Law). D I am exempt under Section _______ Business and Professions Code for this reason: (Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's license Law (Chapter 9, commencing with Section 7000 of Division 3 of the Business and Professions Code) or that he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars [$500]). SIGNATURE DATE COMPL1IE IRIS SEEi ION FOR NON-RESIDEN IIAL BUILDING PERMll'S ONLV: Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? □YES □NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? □ YES □ NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? □YES ONO IF ANY OF TIIE ANSWERS ARE YES, A FINAi.CERTIFiCATE OFoa:uPANCYMAYNUf BE isgJJID AFTER JULY 1, 1989 UNLESS nmAPPUCANT HAS MIIT OR IS MEIITING nm RF.QUIREMENTS OF TIIE OFFICE OF EMERGENCY SERVICES AND nm AIR POILlTI10N WNTIIOL DISllUCT. 9. WNSIKUCIION 1.£NOING AGENCY I hereby afhrm that there ts a construction iendmg agency for the performance of the work ior which this permit ts issued (Sec 3697(1) dVJI Code). LENDER'S NAMINONE LENDER'S ADDRESS IO. XPPLiCAN I Cl!klOICAilUN I certify that I have read the apphcat1on and state that the atx>ve mformauon 1s correct. I agree to comply wnh all City ordmances and State laws relating to building construction. I hereby authorize representatives of the City of Carlsbad to enter upon the above mentioned property for inspection purposes. I ALSO AGREE 1U SAVE INDEMNIFY AND KEEP JIARMLl'.SS nm CITY OF CARISBAD AGAINST ALL LIABlllTIES, JUDGMENTS, CDSTS AND EXPENSES WIIlCII MAY IN ANY WAY MDUJE AGAINST SAID CITY IN WNSEQIIENCE OF TIIE GRANTING OF TIIIS PERMIT. OSHA: An OSHA permit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height. Expiration. Every permit issued by the Building Official under the provisions of this Ccxle shall expire by limitation and become null and void if the building or work authorized by such permit is not commenced within 365 days from the date of such permit or if the building or work authorized by such permit is suspended or abandoned at any time after the work is commenced for a period of 180 days (Section 303(d) Uniform Building Ccxle). DATE: R:21:/ 90 APPLICANT'S SIGNll,TURE '----&q.-1 e-1,...,_L.1...., ~~ WI-IlTE: File YEIJ.OW: Applicant PINK: Finance